Global HIV Suppression Rates Fall Short of Targets
Fewer children and adolescents with HIV infection are close to meeting global viral suppression goals compared with adults, an international research consortium ’s study suggested. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

COVID-19 Cuts Life Expectancy in Dozens of Countries
The COVID-19 pandemic appears to have halted a more than decade-long increase in life expectancy, according to global mortality data that showed decreases in 2020 in 31 out of 37 high-income countries. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Vaccine Passports Help Boost Lagging Vaccination Rates
Policies requiring people to show proof that they ’ve been vaccinated against COVID-19, recovered from the illness, or recently tested negative for SARS-CoV-2 before they can travel internationally or go to nightclubs, gyms, or other public places could increase vaccinations in countries with low uptake, according to a study of these policies in 6 European countries. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Evaluating the Patient With a Pulmonary Nodule
This Review discusses pulmonary nodules and optimal treatment of an individual with a pulmonary nodule that can lead to early detection of cancer while minimizing testing for a benign nodule. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

The Hardest Step
In this narrative medicine essay, a neonatologist describes the steps taken to revive distressed neonates after birth, the steps to comfort staff when the battle is lost, and the steps to inform and be present as parents weep, yet wonders how to take the steps needed to process her own pain. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Air
She breastfed my sister as I played at the base of her chair. Sunbeams pierced the window, landing on my arms with startling warmth. Her soft voice, “It won’t hurt you.” Particles swam in the light, And I suddenly grasped they were there all the time. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Patient Information: Polycystic Ovary Syndrome
This JAMA Patient Page describes polycystic ovary syndrome (PCOS) and its symptoms, diagnosis, and options for treatment. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic
This retrospective study compares ambulatory care patterns before and in the first year of the COVID-19 pandemic among patients insured by public and private insurance programs. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Hospitalized Patients With COVID-19
This randomized clinical trial evaluates the benefits and risks of the addition of a P2Y12 inhibitor to anticoagulant therapy compared with anticoagulant therapy only among non –critically ill patients hospitalized for COVID-19. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Mortality, Care Practices, and Other Outcomes for Extremely Preterm Infants in the US, 2013-2018
This prospective observational study assesses mortality, in-hospital morbidity, care practices, and 2-year outcomes among US infants born at 22-28 weeks ’ gestational age in 2013-2018 and compares these outcomes with those of a similar cohort of infants born in 2008-2012. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women —Reply
In Reply In response to the concerns Dr Chen and colleagues express regarding our trial on fractional carbon dioxide laser for postmenopausal vaginal symptoms, we can confirm that the vaginal tissues were dried per standard procedure with this treatment. First, anesthetic cream, which was applied for 30 minutes, was removed with a dry gauze, then large, cotton-tipped swabs were inserted into the cervix or the vaginal vault to remove all residual vaginal moisture. In addition, the laser probe was inserted into the vagina without lubrication. Second, the suggestion that vaginal mucosa wetness should be measured has no clinic...
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Prophylactic Scopolamine Butylbromide and Death Rattle in Patients at the End of Life —Reply
In Reply In the Netherlands, patients who are admitted to a hospice facility have a maximum estimated life expectancy of 3 months and are expected to stay in hospice until death. At admission, symptoms, care needs, and expectations around dying are always discussed with patients and their relatives by the hospice physician and the nurse. Obtaining informed consent for our study was embedded in the procedure of admission to the hospice facility. For patients meeting study inclusion criteria, our study trial was introduced at the end of the intake interview. Introduction of the study included information about the possibilit...
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women
In this study, 4% lignocaine topical anesthetic cream was applied to the vaginal introitus for 20 minutes to reduce tactile difference or pain perception in both groups. It is unclear whether there was any residual moisture on the vaginal wall because this information was not reported in the study. Moreover, vaginal mucosa wetness is an important baseline variable that should be measured and reported before insertion of the vaginal probe to exclude the effect of vaginal mucosa surface wetness in the 2 groups on treatment results. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women
To the Editor I have several questions about the study investigating the effect of fractional carbon dioxide laser vs sham treatment on symptom severity in women with postmenopausal vaginal symptoms. First, I would like to know whether this study ’s treatment protocol included a 90° probe introital treatment in addition to the straight probe vaginal treatment. In clinical practice, this additional introital therapy substantially enhances the treatment effect of the carbon dioxide laser therapy. Second, in relation to the histological eval uation of the vaginal tissue before and after treatment, do the authors hav...
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women
To the Editor We have several concerns about the recent study by Li et al. First, specific groups of women who were not the focus of this trial may benefit from fractional carbon dioxide laser treatment. As mentioned by the authors, this study was not powered to examine the efficacy of vaginal laser treatment on patients with breast cancer. Women receiving endocrine therapy for breast cancer typically have more severe vaginal symptoms associated with menopause and more vaginal atrophy and theoretically could derive a larger relative benefit from laser treatment. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Prophylactic Scopolamine Butylbromide and Death Rattle in Patients at the End of Life
To the Editor The SILENCE trial demonstrated not only the efficacy of prophylactic subcutaneous scopolamine butylbromide for preventing death rattle but also the feasibility of randomized clinical trials during the dying phase. Establishing evidence in palliative care through randomized clinical trials is difficult in many ways, and clinical trials in palliative care have a high attrition rate because their target population is highly vulnerable. Although the results of this trial are valuable, we have several concerns and believe that addressing these points will make it more feasible to conduct clinical trials in the end...
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

The Referendum on Alcohol
In hearings before Congress, in the discussion of regulations issued by the Internal Revenue Department, in fact, in practically every discussion of prohibition, contradictory statements have been made as to the views of physicians on the value of alcoholic beverages as therapeutic agents. Several scientific organizations have adopted resolutions on the subject. So far as we know, however, no attempt has heretofore been made to ascertain, in a direct way, the opinions of any considerable number of physicians. … (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Polycystic Ovary Syndrome
This JAMA Insights outlines the diagnostic criteria for polycystic ovary syndrome (PCOS), strategies for treatment, and other considerations such as fertility, cardiometabolic risk, and mental health. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Developing Drugs for Life-threatening Genetic Diseases
The FDA recently issued 2 draft guidances related to the development of individualized new drugs for the treatment of severely debilitating or life-threatening genetic diseases. Usually, patients with these diseases have no other treatment options, and their illness progresses rapidly without treatment, according to the FDA. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Regulation of 3D Printing at Health Care Facilities
Pandemic-related medical device shortages due to supply chain disruption have spurred hospitals, physicians ’ offices, and other health care facilities to rely on 3-dimensional (3D) printing to produce face shields, face mask holders, nasopharyngeal swabs, and ventilator parts from locally available materials. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Improving the Response to Foodborne Illness Outbreaks
Strengthening analysis and dissemination of data and using new technology to streamline tracking down sources of foodborne illness outbreaks are among the FDA ’s priorities as set forth in its recently released Foodborne Outbreak Response Improvement Plan. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Antiplatelet Therapy in Patients With COVID-19
Because venous and arterial thromboembolism are common among patients hospitalized with COVID-19, anticoagulant therapies were among the first to be evaluated in clinical trials to improve outcomes in moderately ill patients hospitalized with COVID-19. These studies have yielded thus far somewhat mixed results, varying from beneficial effects of therapeutic doses of low-molecular-weight heparin in the ATTACC, ACTIV-4a, and REMAP-CAP trials to no difference between therapeutic and prophylactic doses of low-molecular-weight heparin in the INSPIRATION, ACTION, and RAPID trials. Therefore, it remains to be determined whether t...
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Progress, Problems, and Prospects in Intensive Care of Extremely Preterm Infants
Advances in perinatal medicine have increased survival after preterm birth. What used to be a late miscarriage 50 years ago is now a developmental starting point for a whole new generation of children. The improvement is illustrated by almost universal survival (>97%) among the 383  061 preterm births that occurred in the US in 2019, translating into an estimated 6.5 million childhood survivors (age 0-18 years) of preterm birth. Consequently, the number of individuals born preterm who reach adulthood also is increasing. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Incorrect Equivalent Dose and P Values in Figure 3
This article was corrected online. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Incorrect Spelling of Author ’s Last Name
This article was corrected online. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Incorrect Surname for Author
This article was corrected online. (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

Blurred Vision and Gastrointestinal Bleeding in a Patient With HIV
A 57-year-old man with HIV (CD4 cell count, 16/mm3; HIV viral load>10 million copies/mL) had blurred vision, weight loss, and gastrointestinal bleeding. A sample of small bowel showed inflammation of the lamina propria, with numerous cytoplasmic and nuclear inclusions with an “owl eye” appearance; dilated retinal examination revealed extensive macular hemorrhage with peripapillary whitening. What is the diagnosis and what would you do next? (Source: JAMA)
Source: JAMA - January 18, 2022 Category: General Medicine Source Type: research

PrEP Awareness Is Low Among Heterosexual People
Although nearly one-third of heterosexually active adults in cities with high HIV prevalence are aware of preexposure prophylaxis (PrEP), less than 1% use it, according to a CDC analysis of 2019 National HIV Behavioral Surveillance (NHBS) data. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Younger Adults With Diabetes Miss Care, Disregard COVID-19 Precautions
Recent data showing that nearly 9 in 10 young adults with diabetes delayed medical care during the pandemic add to growing evidence of COVID-19 ’s disruptions in diabetes management. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

New State Consumer Protections Against Medical Debt
This Viewpoint discusses how US states have tried to protect residents against medical debt and outlines where gaps remain, including the income thresholds set for financial assistance, the need for limitations on legal actions taken against individuals with medical debt, and a lack of data on debt collection actions by health care entities and clinicians. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Diagnosis and Treatment of Sexually Transmitted Infections
This review summarizes current evidence regarding the epidemiology, diagnosis, treatment, and prevention of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

My Dad ’s Sneakers
In this narrative medicine essay, a medical student recounts the final days of his father who died of COVID-19 and finds comfort by understanding the uniqueness of his loss and from the universal experience of the millions who also lost loved ones to the virus. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

The Last Goodbye
erupted from my father ’s mouth in a thin stream of blood, his body slumping forward against my shoulder, almost lifting like a jockey relieving his horse of his weight. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Patient Information: Cystic Fibrosis
This JAMA Patient Page describes cystic fibrosis, how it affects different parts of the body, and the treatments available. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Effect of Weekly Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes
This clinical trial compares the efficacy and adverse event profiles of once-weekly subcutaneous semaglutide, 2.4 mg, vs once-daily subcutaneous liraglutide, 3.0 mg (both with diet and physical activity), in people with overweight or obesity. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Effect of Anticoagulant Therapy for 6 Weeks vs 3 Months on Recurrence and Bleeding Events in Young Patients
This randomized clinical trial tests the hypothesis that a 6-week duration of anticoagulant therapy for provoked venous thromboembolism is noninferior to a conventional 3-month therapy duration in patients younger than 21 years of age. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Discriminative Accuracy of COPD Screening Instruments in Low- and Middle-Income Countries
This cross-sectional study assesses the discriminative accuracy of 3 screening instruments in identifying chronic obstructive pulmonary disease in Nepal, Peru, and Uganda. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

A Pulmonary Embolism Diagnostic Strategy in Patients Hospitalized for COPD Exacerbation —Reply
In Reply Drs Xiong and Guo express some concerns about the SLICE trial. First, we would like to clarify that every randomized clinical trial should be considered in the context of its eligibility criteria. Since patients, including those with COPD, in whom PE is suspected based on their initial symptoms should undergo evidence-based diagnostic criteria, they were excluded from our trial. It would not have been ethical to randomize patients with a clinical suspicion of PE to the study intervention or to usual care. Our study results will help clinicians make decisions about the need for an active diagnostic strategy in pati...
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Saliva RT-PCR Sensitivity Over the Course of SARS-COV-2 Infection —Reply
In Reply In our Research Letter, we reported that saliva was more likely to detect SARS-CoV-2 in the 163 infected symptomatic individuals compared with 93 infected asymptomatic individuals based on nasopharyngeal swabs. This difference was most significant during the first 2 weeks of acute infection, with sensitivities of 88.2% vs 58.2% at week 1 and 83.0% vs 52.6% at week 2 (both P  
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Effect of Lactobacillus rhamnosus GG on Incident Pneumonia in Critically Ill Patients —Reply
In Reply Dr Wang and colleagues express concerns about some interventions in the PROSPECT trial that may have influenced the risk of VAP. However, during their ICU stay, the probiotic and placebo groups had similar exposure to proton pump inhibitors (59.6% vs 60.5% of ICU days), histamine 2 receptor antagonists (23.1% vs 22.7% of ICU days), and corticosteroids (19.5% vs 19.7% of ICU days). In addition, patients taking immunosuppressants were excluded from our trial. We did not collect data on paralytics or weaning and did not conduct adjusted analyses for postrandomization exposures. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

A Pulmonary Embolism Diagnostic Strategy in Patients Hospitalized for COPD Exacerbation
To the Editor In the SLICE trial, implementation of an active strategy for the diagnosis of pulmonary embolism (PE) did not significantly improve a composite health outcome compared with usual care alone among patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD). We would like to express some concerns about this study. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Saliva RT-PCR Sensitivity Over the Course of SARS-COV-2 Infection
To the Editor In their Research Letter, Mr Congrave-Wilson and colleagues reported findings from the Household Exposure and Respiratory Virus Transmission and Immunity Study (HEARTS) comparing SARS-CoV-2 detection in symptomatic and asymptomatic populations. However, we have concerns that this study ’s conclusions about clinical diagnoses and the utility of each sample type were not robustly supported by the study design. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Effect of Lactobacillus rhamnosus GG on Incident Pneumonia in Critically Ill Patients
To the Editor The recent trial investigating the effect of probiotics on the risk of ventilator-associated pneumonia (VAP) in critically ill patients found no difference in the primary outcome of incidental VAP and 20 other prespecified secondary outcomes between patients receiving probiotics and those receiving placebo. Based on these findings, the authors recommended against the use of Lactobacillus rhamnosus GG for critically ill patients. However, we have several concerns. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Important Contribution to Egyptian Medicine
One of the most important announcements made at the recent annual meeting of the American Historical Association at St. Louis is of special interest to physicians. Professor Breasted of the University of Chicago told of the recent discovery in this country, where it has been for a number of years without its value being recognized, of an Egyptian papyrus on medical science. This proves, indeed, on investigation to be one of the four most important medical documents from Egypt which the modern world has discovered. These four are the Ebers Papyrus of Leipzig, the Berlin Medical Papyrus, the Hearst Medical Papyrus, which is ...
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

A Plea for Accuracy
Inaccuracy of description is a common sin in medical literature. Some articles give the reader the impression that the author has not been informed that there exist standard systems of weights and measures. We are told that a nodule the size of a chestnut was present in the abdominal wall, or that an ulcer the size of a dime was located on the forearm. These descriptions may mean something to the writer who saw the objects, but they carry much less information than they should to the reader. Too many writers seem to forget that medical literature is international, and that their reports, if of any value, will be read in al...
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research

Using Cardinality Matching to Design Balanced and Representative Samples for Observational Studies
This JAMA Guide to Statistics and Methods discusses cardinality matching, a method for finding the largest possible number of matched pairs in an observational data set, with the goal of balanced and representative samples of study participants between groups. (Source: JAMA)
Source: JAMA - January 11, 2022 Category: General Medicine Source Type: research